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Cross sectional study of mode of delivery and maternal and perinatal outcomes in mainland China.

Cross sectional study of mode of delivery and maternal and perinatal outcomes in mainland China.
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Hou L, Hellerstein S, Vitonis A, Zou L, Ruan Y, Wang X, Zhang W,


Hou L, Hellerstein S, Vitonis A, Zou L, Ruan Y, Wang X, Zhang W, (click to view)

Hou L, Hellerstein S, Vitonis A, Zou L, Ruan Y, Wang X, Zhang W,

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PloS one 2017 02 0912(2) e0171779 doi 10.1371/journal.pone.0171779
Abstract
BACKGROUND
Cesarean delivery (CD) rates have risen globally with nearly 50% of the non-indicated CDs worldwide in China and Brazil. In China’s One Child Policy era (1979-2015) most deliveries were women having their only child. Family size is a major determinant of the safety of medically non-indicated CD or CD on maternal request. The goal of this study is to document CD rates, indications, and analyze the relative safety of non-indicated CD compared to SVD and intrapartum CD.

METHODS
Univariate and multivariate logistic regression analyses of the association between mode of delivery and short-term maternal and perinatal outcomes were performed on a cross-section of all deliveries at 39 hospitals in 14 provinces of China in 2011, presented as adjusted odds ratio (aOR), 99% confidence intervals (CI).

FINDINGS
Among 108,847 deliveries, 59,415 were CD (54.6%) with 20.8% of deliveries or 38.2% of all cesareans were non-indicated CD. Compared to SVD, antepartum non-indicated CD was associated with a decreased likelihood of post-partum hemorrhage (PPH) (aOR = 0.80, CI = 0.69-0.92) and was not associated with maternal death or combined severe outcomes (maternal death, transfusion, or hysterectomy). Intrapartum indicated CD was associated with an increased risk of PPH (aOR = 1.68, CI = 1.50-1.89) compared to SVD. Compared to SVD, antepartum non-indicated CD was associated with lower likelihood of neonatal death (aOR = 0.14, CI = 0.06-0.34), neonatal ICU admission (aOR = 0.50, CI = 0.36-0.69), 5-minute Apgar<4 (aOR = 0.06, CI = 0.10-0.36), and respiratory distress syndrome (RDS) (aOR = 0.31, CI = 0.16-0.58), but not significantly associated with changes in rates of infection, hypoxic ischemic encephalopathy (HIEE), birth trauma or meconium aspiration rates. CONCLUSIONS
In 2011 when 81% of deliveries were women having their first child antepartum non-indicated CD had short-term maternal and perinatal outcomes as safe as SVD. Now that all Chinese women can have a second child the safety profile may change.

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